Effective hand hygiene, whether using soap and water or an alcohol-based hand rub (ABHR), is crucial for preventing the spread of infectious diseases. The choice between washing and sanitizing depends on the goal: physically removing contaminants or quickly inactivating microbes. Understanding these differences is necessary for protecting personal health.
Distinguishing Between Handwashing and Hand Sanitizer
The primary factor guiding the choice between handwashing and sanitizing is the visible state of the hands. If hands are visibly soiled with dirt, grime, or bodily fluids, soap and water are mandatory. Soap contains surfactants that lift and suspend soil and microbes from the skin, which is then rinsed away by running water. This mechanical action removes visible contaminants that would otherwise shield microbes from alcohol-based sanitizers.
Alcohol-based hand rubs (ABHRs) are the preferred alternative for routine decontamination when hands are not visibly dirty. Sanitizers work by rapidly killing microorganisms on the skin rather than removing them physically. This method is often faster and more accessible, providing a quick reduction in pathogens.
Proper Technique for Alcohol-Based Hand Rubs
The effectiveness of an alcohol-based hand rub depends entirely on correct application, ensuring all hand surfaces receive the germ-killing agent. Apply the recommended amount of product to the palm of one hand, using enough to completely wet both hands. Effective sanitizers contain at least 60% alcohol, which should be verified on the product label.
Next, rub the hands together, covering all surfaces, including the backs of the hands, between the fingers, and under the fingernails. Continue rubbing the hands until they are completely dry, which should take approximately 20 seconds. Allowing the product to air-dry naturally ensures the alcohol has sufficient contact time to inactivate the microbes.
Situations Requiring Soap and Water Regardless of Appearance
Even when hands appear clean, specific situations require soap and water due to the limitations of alcohol-based hand rubs. Sanitizers are ineffective against certain microbes that are resistant to alcohol-based formulations. Non-enveloped viruses, such as Norovirus, and spore-forming bacteria, like Clostridioides difficile (C. diff), require the physical removal action of washing.
These resistant pathogens necessitate soap and water, even if hands are not visibly soiled. The friction of scrubbing combined with rinsing physically removes the resistant microbes and spores from the skin surface. Other situations requiring washing include after using the restroom, before preparing or eating food, and after handling raw meat or garbage. These activities carry a high risk of contamination that only thorough washing can address.